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Zvi SAN JOAQUIN COUNTY Cry]ENVIRONMENTAL HEALTH.DEPARTMENT <br /> cEP T 0 0007 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone:(?09)468-3420 Fax: (209)464-0138 Web: www-sjgov,Org/ehd Am <br /> fiv <br /> E�lV1:ti.�W0,EI i ;i_, L. <br /> 30 V <br /> �C�-S PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: . �� rp�yi/S BUSIN88SIAGENCY: ftil "'em <br /> ADDRESS: LA-1a f ffj:k 1"O k Din A'F_ 9 <br /> PHONE(1): PHONE(2): FACSIMILE:_.. q-Z.•5 <br /> TENTATIVE*APPOINTMENT DATE: Tlmo: _ <br /> (Please allow 10 business days from date of application submittal-•Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$98.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DAVE <br /> Electronle information: ❑List❑Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Straw t1 Street Name City ❑ Unit i <br /> ( �. _:h No-big Zq <br /> 2. D _ !?. UST lcE,82_ 0 Unit2 <br /> 4. - r nit 3 <br /> 6. Unit 4 <br /> 7. <br /> (3. Unit 5 <br /> 9. <br /> �a. <br /> --- Unit 6 <br /> Specific bate Range of Information Requested: From to <br /> ///''' ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> Lu DERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT Ll SOLID WASTE FACILITY/VEHICLE <br /> ��T. R CLEANUP 317E(NON-LOP) ❑FOOD FACILITY ClWAflTE TIRE <br /> DERGROUND TANK(MONITORINGIREMOVAL) ❑DO(i KENNEL IJ DAIRY <br /> HA2ARDOU3 WASTE GENERATOR 0 CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑T>ERED PERMITTED FACILITY ❑MOTEIJHOTEL 0 PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑TATToOIBODY PIERCING ❑POOUSPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WABTe FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORGs ARE AVAILABLE FOR REVILw - MoNDAY-FRIDAY E;00 AM-5:000 - EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fay to 209)464-0138 or mail to the address indicated above., Address <br /> ranges will not be accepted-for additional assistance with file addresses,Contact the EH4.Applications received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant if any EHO files exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The,files will be held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 3. A file that is actively being worked on by EHd staff may not be immediately available for review. A new application may be <br /> submitted when the file is available. <br /> 4. Any file not returned In the same condition as released will be reorganized by EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$98.00 deposit prior to review. <br /> EHd USE ONLY <br /> EHD 40-06 WEE 81Cd2(10T <br /> 10 39bd Tb8Z86LOTCT L1 :60 L09Z/0T/69 <br />